P595. Anti-TNF alfa therapy in patients with inflammatory bowel disease and coronary syndrome: efficacy and safety
A. Indriolo1, M. Senni2, P. Ravelli1, 1Ospedali Riuniti di Bergamo, Gastroenterology and Digestive Endoscopy Unit II, Bergamo, Italy, 2Ospedali Riuniti di Bergamo, Cardiovascular Unit, Bergamo, Italy
30% of patients with Inflammatory Bowel Disease (IBD) are more than fifty years old. A few of these patients have a coronary syndrome (CS) associated. Although anti-TNF therapy is contraindicated in patients with New York Heart Association (NYHA) class III and IV, at today we have only a few knowledge about the biological therapy in patients IBD and CS.
The aim of this study is evaluate the clinical and endoscopic efficacy and related complications of anti-TNF alfa therapy in patients with IBD and CS.
A total of 431 patients with IBD were evaluated in our Center from January 2001 to June 2012. 25 patients (5.8%) have a CS associated: 21 (84%) Ulcerative Colitis (UC) and 4 (16%) Crohn's Disease (CD). All 25 patients underwent a coronary chatheterization and in 19/25 (76%) patients was present a coronary stenosis. They are treated with coronary angioplasty and stent position or aortocoronary by-pass.
4 patients with moderate-to-severe steroid-resistent IBD were been treated with anti-TNF alfa: infliximab (IFX) in 2 UC patients (5 mg/kg, 0–2-6 weeks and every 8 weeks), adalimumab (ADA) in 2 CD patients (160 mg, 80 mg and 40 mg every two weeks). The efficacy of IFX treatment in UC patients had been evaluated with Harvey–Bradshaw Index and Mayo Clinic Endoscopic Score Index. The efficacy of ADA treatment in CD patients had been evaluated with Crohn's disease Activity Index and Simplified Endoscopic Activity Score for Crohn's Disease. Mucosal healing had been definite as absence of ulcerations of mucosa.
IBD and cardiac complications during IFX and ADA therapy have been reported.
4 patients with IBD and CS have been treated with anti-TNF alfa therapy. Clinical remission is present in 2/4 (50%) patients. Mucosal healing in present in 3/4 (75%) of patients. We observed severe infections in 2/4 (50%) of patients, such as Citomegalovirus, Clostridium difficile and acute prostatitis during anti-TNF alfa treatment. No complications of cardiac functional we observed in these patients with CS and IBD.
In our study about 6% of IBD patients over 50 years old have a CS associated. 18% of IBD/CS patients present a Moderate-to-Severe UC or CD. Anti-TNF alfa therapy could be a useful treatment option in these patients but we observed a increased risk of severe infections. No complications cardiac function was observed during anti-TNF alfa therapy.
However, a large study about anti-TNF alfa therapy in IBD/CS patients is necessary to demonstrate our finding.